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General NPI Number Information
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NPI Number | 1194020834
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Entity Type | Individual
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Provider Name | WANDA IVETTE LOPEZ-RODRIGUEZ NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 1105 ROUTE 46
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City | LEDGEWOOD
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State | NJ
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Zip | 07852
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Country | US
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Telephone | 973-927-4662
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Fax | 973-927-4668
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Provider Business Mailing Address
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Address Line | 161 MOUNT OLIVE RD
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City | FLANDERS
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State | NJ
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Zip | 07836-9725
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Country | US
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Telephone | 973-527-4722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00325900
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License Number State | NJ
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